Eyeworld

Reporting from the 29th APACRS annual meeting, July 27–30, 2016, Nusa Dua, Bali Sponsored by EW MEETING REPORTER 80 eyes" that are long, short, steep, flat, or have low/negative diopters. Through a series of cases, he demon- strated the necessity of using special constants or Koch's axial length adjustment when using standard formula for atypical eyes. His series also demonstrated the value of using the Barrett True-K and Universal II formulas. Manual small incision cataract surgery technique, pearls, and advantages A MasterClass on manual small incision cataract surgery (MSICS) delved into each aspect of the proce- dure from start to finish. Attendees learned about wound construction, anterior capsulotomy, nucleus management, capsulectomy, and IOL implantation, as well as situa- tions where this technique might be preferable to phacoemulsification surgery. Course director Sanduk Ruit, MD, Kathmandu, Nepal, led the class with faculty that included Anuchit Poonyathalang, MD, Bangkok, Thailand, Ganesh Raman, MD, Coimbatore, India, and Nikolle Tan, MD, Singapore. "Because of the backlog of cataract, cataract continues to be the most prevalent cause of blindness," Dr. Ruit, who is credited with first between eyes. "Not that this is not possible, but check to make sure anyway," he said. Good axiometry practice re- quires ensuring fixation, checking for good signals/waveforms, and excluding staphyloma. "Repeat if axial length is too short or too long especially if they do not correlate with the other eye." Fifth, and following on his point regarding correlation between the two eyes of each patient, Dr. Fam said surgeons should always perform bilateral biometry, even if the patient is only asking for surgery on one eye. Sixth, always use the right formula. Finally, Dr. Fam said that surgeons should always check the ocular status. "Don't forget to ask the patient for his or her refractive history," he said. "So many patients have had LASIK, and this will affect your calculation. You might want to screen the patient's topography." Dr. Fam further recommended a thorough clinical examination— check the anatomic ocular status, for instance in terms of media changes, retinal detachment, and macular changes. In addition to these pearls, Dr. Fam presented a comparison of various IOL formulas in atypical eyes—not eyes that have undergone prior refractive surgery but "virgin year, with the aim of making the complexities of IOL power calcula- tion and biometry comprehensible to attendees. The course faculty pro- vided pearls for optimizing refractive outcomes in a variety of challenging situations. "Biometry is far more import- ant than we give it attention to," said Fam Han Bor, MD, Singapore. "We always start with refraction. With LASIK, if we don't have a good refraction, we don't expect a good refractive outcome. The same with cataract surgery—if you don't do good refraction, you can't expect a good refractive outcome. "IOL formulas are just like drugs—prescribe the wrong drug and you get the consequences," Dr. Fam said. In fact, in some ways IOL formulas can lead to "far more disastrous consequences" because while you can always change a drug during the treatment, once you've used the wrong biometry, it may be too late to do anything. Dr. Fam offered some pearls for achieving good biometry. First, he said, it is "beyond doubt" that optical biometry is "far superior" to ultrasound. In his practice, they have increased the penetration of optical biometry from using it in 70% of their patients to practically all of their cases. Second, the biometry machine must be calibrated. Just about all new optical biometry machines re- quire you to calibrate whenever you switch them on, Dr. Fam said. "If you do not calibrate, you may not get good outcomes," he said. "Cali- brate as frequently as you can." Third, for good keratometry practice, "make sure you have a good corneal surface before you measure," he said. "Do keratometry first," before instilling any drops. If patients are using contact lenses, make sure they stop before perform- ing keratometry. Dr. Fam recommended having patients stop contact lens use two weeks prior to measurement for hard contact lenses and at least a week for soft contact lenses. For data validation, Dr. Fam said that surgeons should repeat ker- atometry if the difference of average corneal power is greater than 1.0 D August 2016 continued on page 82 View videos from APACRS 2016: EWrePlay.org Donald Tan, MD, discusses the technique and advantages of hybrid DMEK with modified tissue preparation and insertion.

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